Global And Regional Cardiac Function In Lifelong Endurance Athletes With And Without Myocardial Fibrosis

Abstract

PURPOSE: The aim of the present study was to compare cardiac structure as well as global and regional cardiac function in athletes with and without MF. METHODS: Cardiac magnetic resonance imaging with late gadolinium enhancement was used to detect MF and global cardiac structure in 9 lifelong veteran endurance athletes (58±5 years, 43±5 years of training). Transthoracic echocardiography using tissue-Doppler and myocardial strain imaging assessed global and regional (18 segments) longitudinal left ventricular function. RESULTS: MF was present in 4 athletes (range 1-8 g) and not present in 5 athletes. MF was located near the insertion points of the right ventricular free wall on the left ventricle in 3 athletes and in the epicardial lateral wall in 1 athlete. Athletes with MF demonstrated a larger end diastolic volume (205±24 vs 173±18 ml, p=0.06) and posterior wall thickness (11±1 vs 9±1 mm, p=0.03) compared to those without MF. The presence of MF did not mediate global tissue velocities or global longitudinal strain (-22.0±4.3 vs -21.7±1.8) and strain rate (S’: -0.97±0.19 vs -1.02±0.11; E’: 0.95±0.20 vs 0.90±0.15; A’: 0.61±0.16 vs 0.66±0.17), however, regional analysis of longitudinal strain demonstrated reduced function in 5 out of 8 wall segments associated with the presence of MF in 3 athletes (Figure). CONCLUSIONS: MF is associated with larger cardiac dimensions, normal global cardiac function but evidence of co-localised regional cardiac dysfunction in lifelong veteran endurance athletes. Given the heterogeneous phenotype of MF, we propose that follow-up studies and a case-by-case approach are needed for appropriate risk assessment in athletes with MF.